Worksheet 4
Concerns
At each visit, your doctor will likely ask about your concerns. It’ s a good idea to think about what you’ d like to talk about before the actual visit. This form can help you organize your thoughts.
Tear out this form and make a copy of the blank form so you will always have a clean copy to use. Or download additional copies from NIA’ s website at www. nia. nih. gov / health / twyd-worksheets. Then, after you make an appointment, take a minute to write down the name of the doctor and the appointment details( for example, the date, time, and address). Use the form to make a list( in order, from most important to least important) of the concerns you want to discuss.
Doctor: Appt. Date:
Time:
Address: Phone:
Appointment Details( Most Important to Least Important)
1.
2.
3.
4.
5.
6.
7.
8.
Notes:
Talking With Your Doctor 45